Southside Virginia Training Center

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

SOUTHSIDE VIRGINIA TRAINING CENTER

Practice address

26317 West Washington Street
Petersburg, VA 23803

Phone

(804) 524-7209

Fax

(804) 524-7228

NPI assigned

Aug 8, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. John Alfred Holland Jr., MD

Title

Facility Director

Phone

(804) 524-7209

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154995200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1154330942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26317 WEST WASHINGTON STREET",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23803",
            "telephone_number": "804-524-7209",
            "fax_number": "804-524-7228"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26317 WEST WASHINGTON STREET",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23803",
            "telephone_number": "804-524-7209",
            "fax_number": "804-524-7228"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHSIDE VIRGINIA TRAINING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-08",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ALFRED",
        "authorized_official_title_or_position": "FACILITY DIRECTOR",
        "authorized_official_telephone_number": "804-524-7209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual Disabilities Intermediate Care Facility in Petersburg, VA
• Providers in Petersburg, VA by specialty
• Intellectual Disabilities Intermediate Care Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.